Recently due to some issues with my mother, I have spent alot of time talking to doctors. I’ve spoken to about seven seperate ones. Every time I see a doctor I feel as though I have exactly two seconds with him/her. Are doctors ALWAYS in a legitamite rush, or do they sometimes rush you just out of habit?
If you spoke to someone on the phone between 9 and 5, then they’ll be busy. If you spoke to someone in a clinic then they’ll be busy. If you have made an appointment at a time of their choosing to speak to someone, no, they shouldn’t be busy.
But… the thing is, it’s not constantly busy, it’s either the calm or the storm, and if it’s calm you know the storm is just around the corner…
I fill in at my husbands practice when anyone is out. He is unbelievably busy. The reason is that they double book patients to try to get people in faster, even so thye are still booked out until mid July. He sees an average of 50 patients a day, some for just a “hi hows it going…” follow up, some for a consult, others for a minor procedure. Bigger surgery is scheduled on other days. Anyway, that doesn’t leave much time to each patient, but you try to give each one what they need. He makes it a practice of always greeting then sitting down, not hovering at the door with hand on door knob…people get mad when they wait 60min and then get 3 in return.
How do docs keep all that information straight? Who they saw, why they saw them, what follow-ups are needed. I know there’s charts, but still… How do they focus on a patient when they just saw 20 and they have 20 more to go?
Not a snarky question, I really am curious!
Most doctors make more money the more patients they deal with. They have an incentive to keep their day filled up. The more patients they see, the more money the make.
(This is not a knock on their ethics in any way, just the cold reality of their economics.)
My doctor uses a mini tape recorder that he dictates into while he is examining patients. An employee later transcribes to the chart.
True, but I once worked for a system where your salary was based on your “production” (the number and complexity of patients you saw and procedures you did) and if you fell below what they considered an acceptable level, you got terminated. Even if you chose to see fewer patients, and make less money, so you could spend more time with your patients. The organization expected you to generate a certain level of profit for them, and if you didn’t make that number for them, they had no compunction about replacing you with someone who would.
A lot of well-respected, competent docs got let go when this system took over my original group, because those docs didn’t meet production expectations. (I left before I got ‘downsized’).
This sort of set-up is becoming much more common in primary care in the US.
My daughter’s sinus surgeon is also my sleep study doc. He uses a laptop to take notes while he speaks to the screen. It is completely appalling. He glances at me, or daughter for a few seconds, then turns to screen and types as he talks.
If he has to examine us, he does so with focus and care and great speed. But most of the time, we sit in the room with him and speak but he barely looks at us.
This is so that he does not have to pay someone to transcribe mini cassettes. Welcome to modern medicine. I am not a patient with a medical issue, I am A Billable Unit Of Time.
And nothing more. 
Cartooniverse
The doctors are usually getting paid by a third party like an insurance company. The insurance company’s incentive is to cut its reimbursement rates to the point where the doctor makes as little profit as possible for each patient he sees.
The doctor isn’t in a very good negotiating position with the insurance company. The insurance company is big and powerful and probably spends a lot of time figuring out the minimum possible reimbursements that doctors will accept. If a doctor drops a few insurance companies, his revenue will take a big hit. If the insurance company loses a few doctors, they will hardly notice it.
So the doctor’s incentive is to frantically pack in as many patients as possible.
Another factor is surely the urgent call-ins. The doc and his staff schedule a reasonable day, then a dozen patients call with problems that can’t wait a couple of days. There goes the schedule.
I think this is unfair. The doctor is likely writing directly into your medical record, which obviates transcription errors, and makes your clinical history instantly accessible to others providers with access to the system. I don’t know what you mean exactly by transcribing mini cassettes. Are you thinking that after the appointment, the doctor will dictate notes about your case, which will then be transcribed by somebody into your medical record? To me, not only is that a waste of several people’s time, but it increases the likelihood of error quite significantly.
I’m a big fan of the electronic medical record. It has an important place in making the system overall more efficient, and, I would hope, in giving doctors more time to spend with patients, rather than dealing with paperwork or fixing mistakes.
My mother’s doctor is on the list of Top Doc’s and he teaches and has a practice.
He goes in and reviews her complete chart before he sees her. I’ve seen him do it. He pulls up the chart and goes over everything while he examines her. Then he sits down and talks to my mother like he has all day. She’s never rushed and he makes her feel like any question she has is important.
If you don’t have a doctor that’s treating for what you are, someone that’s paying him for his services, change doctors.
Another thing that ties up doctors time is arguing with insurance companies about getting a patient seen by a specialist Insurance companies often demand exorbitant amounts of detail before they’ll allow someone to see a specialist, and it has to be the doc who discusses this with the insurance company, not someone who works in the office. Also, if the doctor has a patient who is uninsured who needs treatment, the doctor will often call around and try to work deals so that the patient has the treatment done for reduced cost.
Then there’s the constant flow of drug reps that the docs have to contend with.
Would any of you pay more to guarantee a comfortable length of time with the doctor and an appointment that was actually kept? I tend to think I would.
I disagree. If anything, it makes his practice less profitable. Let’s face it – A doctor’s hourly wage is enormously higher than a transcriber. Unless your doctor is an extremely fast typer, I’m sure he’d make more money if he just dictated into a recorder and let somewhat else transcribe it, then doing the typing himself. Especially today, one can easily outsource the transcribing to India for a fraction of the cost.
This, of course, assumes he can fill up that extra time with more patients which is not always true.
As someone else said above, he likely does it for other reasons then to avoid paying a transcriber.
Yes, exactly. It took some hunting, but Mrs Gargoyle finally found a doctor for us that spends more time with us than any of the staff, clerks, nurses, or techs combined. The doctor herself collects all of the data, fills out the forms, asks all of the questions, and personally walks the patients out to the front desk.
It felt like Bizarro World the first time I went, I was actually was smiling to myself the whole time thinking “What’s the catch? There’s always a catch? You’re not really a doctor, are you?”.
I’m finding that this goes for many things in life…you don’t have to endure short, rushed, cranky people for your services. It takes more research, but there are actually service providers in the world that also possess a good work ethic.
It would be nice to spend more time with patients. Unfortunately, the only legal way to do this is to opt out of insurance entirely and have what is called a “boutique” practice, where patients pay cash to see a doctor and spend time with her. However, the patients who have the disposable income to do this are not necessarily the ones who really need the extra time.
Medicine is one of the few areas where it doesn’t matter what you charge; the insurance companies/government in the US decide what you will be paid and you are forbidden to bill the patient extra, even if the patient wants to pay more for more time.
How do I deal? I spend a lot of time with my patients. As a consequence, according to my accountant I actually made less than my receptionist last year. All I hear, over and over again, is that I have to be more efficient, and see more patients in less time in order to make any money. If I were a hairdresser, or a plumber, and I took more time on one job, or the client wanted extra services, I could charge $75 instead of a usual $50. With Medicare, it doesn’t matter whether the patient has one complaint or twenty, or whether I charge $50 or $75, they will pay me their $37 and I am forbidden to bill the patient more than their $10 or so copayment. Lawyers charge for telephone time; the hours I spend on the telephone talking with patients are considered part of the visit described above.
Sorry to be so disillusioned, but sometimes it seems like doctors get so little respect. I may spend 15 minutes with you, but are you including the time I spend reviewing your records and results, calling you back with the results, calling a specialist to beg him to get you in earlier for a procedure, and calling the insurance company to get that procedure approved, when you add up the total time I spend on your care?
As my old man would have said, “Of course they are! There’s a lot of people to kill out there.” He wasn’t a big fan. 
(Lived till 92 though. Never saw a doctor in his life till just before the end. I can just imagine him fuming in Heaven now: “I tolja so!”)
In Canada, doctors get a set fee per visit. I always feel like they are asking me to come back in a week so they can rack up the visits to make more money. (Actually I love my doctor but I’m trying to make a point)
An alternate approach would be to pay the doctor per patient not per visit. A doctor might be restricted to a few hundred patients and be paid whether they see you or not. Then its to the doctor’s advantage to keep them healthy so they have more time for themselves. Quality over quantity.
I’m not an expert and have no idea if this is workable but I thought I would throw it out there for discussion.
Just to be clear, it was my recent dealings with doctors that led me to want to try to work in the medical field. It may have taken them a few days, but they were able to fix my mom. I have a tremendous respect for them.
I think it is the closest thing to evil the manner in which the HMO system is set up right now. Patients are now products and I suspect they are all run by teams of college educated Donald Trump “lets make more money now”-types none of which are doctors.
I cannot even begin to suggest a solution. It is tempting to say that HMOs should be disbanded and care run by the goverment. Then I look at the UK and everything I’ve “heard” about them. Additonally consider this recent convo I had with a 87 women I was transporting:
Me: I have Kaiser. They are non-profit. I think they are great. They run tests just because they are curious.
Women: Are you out of your damn mind? Kaiser killed my sister. She had cancer and they kept telling her that it was nothing. Then she died. Those bastards killed my sister.
After that I started hearing other things about Kasier. Some good, alot bad. So, clearly the solution is difficult to come by. Micheal Moore is getting ready to make a film about HMOs. Hopefully it will have some impact, although I clearly realize that he has alot of critics.